Clinical efficacy of a stannous fluoride toothpaste stabilized with zinc phosphate in reducing supragingival calculus formation compared to a sodium monofluorophosphate toothpaste: A randomized controlled trial.

BackgroundCaries prevalence has declined significantly since the introduction of fluoridated toothpaste. There have been several developments regarding specific active fluoride ingredients but not enough evidence to support one over the other. The purpose of this double-blind randomized controlled trial was to compare salivary fluoride concentrations of different fluoride formulations in the form of toothpaste with and without post-brushing water rinsing in adults.MethodsThe study included 120 participants who were randomly assigned to one of 12 groups (10 participants/group). The toothpaste formulas investigated included (1) fluoride-free (0 ppmF); (2) sodium fluoride (1450 ppmF); (3) sodium monofluorophosphate (1450 ppmF); (4) sodium fluoride and monofluorophosphate combined (1450 ppmF); (5) stannous fluoride and sodium fluoride combined (1450 ppmF); and (6) amine fluoride (1400 ppmF). Block randomisation was used to assign each participant to one of the 12 groups. Participants brushed with 1.0 g of one of the six different toothpaste formulations either with or without post-brushing water rinsing. Saliva was collected at six different times (baseline and at 1, 15, 30, 60, and 90 min/s post-brushing). Samples were analysed using a fluoride ion-specific sensitive electrode connected to an ion analyser.ResultsThe demographic characteristics of the participants were not significantly different among the groups (P > 0.05). Time, toothpaste formulation, and post-brushing rinsing routines had significant effects on saliva fluoride retention (P < 0.05). Amine fluoride-containing toothpaste was the only formula that showed statistically significantly higher concentrations of salivary fluoride at 90 min in both the rinsing and non-rinsing groups. Sodium monofluorophosphate toothpaste did not result in a significant difference compared to the control group at any time point, in both rinsing and non-rinsing groups.ConclusionsBased on the results from this study, no rinsing after toothbrushing in adults can be recommended when sodium monofluorophosphate containing toothpaste formula is used. It also concludes that amine fluoride resulted in a significantly higher saliva fluoride concentration at 90 min in both the rinsing and non-rinsing groups compared to other fluoride toothpaste formulations.Registry: Protocol Registration and Results System (ClinicalTrials.gov).Clinical trial registration number: NCT02740803 (15/04/2016).

Background:The efficacy of fluoridated dentifrices in caries prevention has been well documented and research into various formulations continues for a more effective dentifrice. This study evaluated the anti-caries and anti-plaque efficacy of a dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, and compared it with a non-fluoridated dentifrice.Materials and Methods:A total of 595 school children (12–15 years) were divided into test (302 children) and control (293 children) groups. The test group used the dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, whereas the control group was given a placebo dentifrice. Oral examination for dental caries and plaque assessment was carried out at the start of the study and the children were followed up semiannually up to 18 months. Data were analyzed using repeated-measure analysis of variance (ANOVA) followed by one-way ANOVA.Results:The values for decayed missing filled teeth (DMFT) increased from baseline to 18 month examination from 4.43±2.03 and 4.67±2.25 (P=0.175) to 5.84±2.29 and 5.13±2.30 (P=0.001) for control and test groups, respectively. Similarly, the increase in decayed missing filled surface (DMFS) values were from 6.42±4.10 and 7.06±4.77 (P=0.082) to 8.64±4.51 and 7.92±5.07 (P=0.095) for test and control groups, respectively. The mean DMFT and DMFS values increased for both the groups; however, the increase was less in test group as compared to control group. The baseline plaque score reduced from 2.94±0.72 and 2.91±0.72 (P=0.679), respectively, for control and test groups to 1.33±0.46 and 0.91±0.38 (P<0.001), respectively, at 18 month examination.Conclusion:Results revealed that the test dentifrice was effective in inhibiting the progression of plaque and control of dental caries as compared to the placebo dentifrice.

Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials

A comparison of community based preventative services to improve child dental health

BackgroundThis examiner-blind, stratified, parallel study aimed to evaluate the anti-gingivitis efficacy of a non-aqueous (anhydrous) 0.454% w/w stannous fluoride toothpaste (‘Test’) versus a sodium monofluorophosphate toothpaste (‘Control’) in people with clinically-confirmed mild-moderate gingivitis. Plaque-induced gingivitis can progress to irreversible periodontitis if left untreated. This can be controlled by an effective oral hygiene regimen such as one including toothbrushing with a toothpaste containing the chemotherapeutic agent stannous fluoride. Long-term studies over 4–12 weeks have shown the efficacy of stannous fluoride; however, shorter term studies are needed to examine if the effects on measures of gingivitis and plaque control occur sooner.MethodsEligible participants were randomised to 3 weeks’ twice-daily brushing (for 1 min) with Test or Control toothpastes. The primary efficacy variable was between-treatment difference in Bleeding Index (BI) at 3 weeks; secondary variables were between-treatment differences in number of bleeding sites, modified Gingival Index (MGI), and Turesky modification of the Quigley–Hein Plaque Index (TPI) at Weeks 2 and 3.ResultsA statistically significant (p < 0.0001) lower BI score was reported for Test (n = 65) versus Control (n = 65) groups at Week 2 (mean difference: − 0.07 [95% CI − 0.9, − 0.05]; 32.7% difference) and Week 3 (mean difference: − 0.06 [95% CI − 0.8, − 0.04]; 29.2% difference). The Test group also demonstrated statistically significant lower (all p < 0.0001 versus Control) number of bleeding sites (Weeks 2/3 mean difference [95% CI]: − 10.04 [− 12.3, − 7.5]/ − 8.2 [− 11.1, − 5.3] sites; 33.0%/29.3% difference); MGI score (Weeks 2/3 mean difference [95% CI]: − 0.09 [− 0.13, − 0.06]/ − 0.10 [− 0.14, − 0.06]; 4.3%/4.7% difference); overall TPI score (Weeks 2/3 mean difference [95% CI]: − 0.45 [− 0.55, − 0.35/ − 0.42 [− 0.53, − 0.30] difference; 16.0%/15.1% difference) and interproximal TPI score (Weeks 2/3 mean difference [95% CI]: − 0.42 [− 0.52, − 0.30]/ − 0.41 [− 0.52, − 0.29]; 14.6%/14.1% difference). Both toothpastes were generally well tolerated.ConclusionThree weeks’ twice-daily brushing with the 0.454% w/w stannous fluoride Test toothpaste compared to the Control toothpaste led to statistically significant lower gingival bleeding, gingival inflammation and plaque levels in adults with mild-moderate gingivitis. These results indicate that plaque and gingivitis-reducing benefits of 0.454% w/w stannous fluoride may be seen from 2 weeks’ use.Trial registration ClinicalTrials.gov Identifier: NCT04050722; 08/08/2019.

Various ingredients are utilized to inhibit the growth of harmful bacteria associated with cavities, gum disease, and bad breath. However, the precise mechanisms by which these ingredients affect the oral microbiome have not been fully understood at the molecular level. To elucidate the molecular mechanisms, a high-throughput bacterial transcriptomics study was conducted, and the gene expression profiles of six common oral bacteria, including two Gram-positive bacteria (Actinomyces viscosus, Streptococcus mutans) and four Gram-negative bacteria (Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, and Prevotella pallens), were analyzed. The bacteria were exposed to nine common ingredients in toothpaste and mouthwash at different concentrations (stannous fluoride, stannous chloride, arginine bicarbonate, cetylpyridinium chloride, sodium monofluorophosphate, sodium fluoride, potassium nitrate, zinc phosphate, and hydrogen peroxide). Across 78 ingredient-microorganism pairs with 360 treatment-control combinations, significant and reproducible ingredient-based transcriptional response profiles were observed, providing valuable insights into the effects of these ingredients on the oral microbiome at the molecular level. This research shows that oral care product ingredients applied at biologically relevant concentrations manifest differential effects on the transcriptomics of bacterial genes in a variety of oral periodontal pathogenic bacteria. Stannous fluoride, stannous chloride, and cetylpyridinium chloride showed the most robust efficacy in inhibiting the growth or gene expression of various bacteria and pathogenic pathways. Combining multiple ingredients targeting different mechanisms might be more efficient than single ingredients in complex oral microbiomes.

English summary Toothpaste containing stannous fluoride – is it useful? 384 – 8. Norwegian news media have recently featured reports about the use of fluorides and dental health. Their interest was aroused when Lilleborg plc ran an advertising campaign for a new toothpaste called «Solidox Syreblokk» (Solidox Acid Blockage). The new toothpaste contains stannous fluoride and stannous pyrophosphate and the advertisement claimed that toothpastes with stannous salts have a long history behind them and that they have been particularly effective against plaque and caries. Another claim was that recent research has shown that stannous fluoride may protect the teeth against erosion. These assertions were based on experiments with fluoride-containing solutions and studies of effects on dental plaque. The purpose of this review was to compare the caries inhibiting effect of toothpastes containing stannous fluoride with that of toothpastes based on other fluoride salts, and to assess possible protective effects against dental erosion. Toothpastes containg stannous fluoride were mainly tested during the 1960s and marketing ceased at the beginning of the 1980s. The literature shows that the caries reduction has been lower among users of stannous than among users of sodium fluoride or sodium monofluorophosphate containg toothpastes. This applies despite the fact that local applications of stannous fluoride has reduced both plaque and gingival index scores. The caries reducing effect of toothpastes containg sodium fluoride or sodium monofluorophosphates has been found to be about equal. No clinical studies have demonstrated any anti-erosion effect of fluorides. Furthermore, the use of agents containing stannous fluoride is associated with brown discoloration of the teeth, especially of demineralised enamel and dentine, a discoloration that is difficult or impossible to remove by toothbrushing. Based on existing knowledge, it is reasonable to conclude that sodium fluoride or monofluorophospate is superior to stannous fluoride as constituents of toothpaste.

Objectives: To evaluate in vitro, the effect of Nano-hydroxyapatite (NHA) toothpaste in comparison with fluoridated toothpaste on remineralization of caries like lesion in the enamel of primary teeth.Materials and methods: sixty sound primary anterior teeth were coated with nail varnish; leaving squares of 3x3 mm on facial surface then 40 teeth of them were divided into two groups. Group (I) n=20 treated by NHA toothpaste and group (II) n=20 treated by fluoridated toothpaste contains sodium monofluorophosphate (1450 ppm F). They were examined with Vickers Microhardness device. The rest 20 teeth were divided into two groups (III and IV). They were sectioned longitudinally in a labiolingual direction into two equal halves, mesial half not treated (sub group IIIA) and distal half treated by NHA (sub group IIIB). Mesial half not treated (sub group IVA) and distal half treated by fluoridated toothpaste (sub group IVB). Specimens were evaluated quantitatively and qualitatively with Polarized Light Microscope.Results: The microhardness of teeth significantly decreased following acid exposure but increased again in both groups after exposure to toothpastes. The NHA toothpaste non-significantly increase percent change of microhardness by 1.65 times than Fluoridated toothpaste (p = 0.06). The percent differences in lesion depth between test group IIIB and its control group IIIA was -58.96 ± 9.04, whereas between test group IVB and its control IVA was -56.26 ± 17.43. There was no statistically significant difference between the two values (P=0.67).Conclusion: NHA and Fluoridated toothpastes are equally effective as remineralizing materials for the enamel.

The purpose of this study was to investigate the effect of a new toothpaste containing an antiplaque and antiinflammatory agent (0.3% triclosan), a desensitizing agent (5% potassium nitrate) and an anticaries agent (0.76% sodium monofluorophosphate (SMFP)) on gingival health, plaque formation and dentine hypersensitivity in a 12-week home study. The efficacy of the test toothpaste was compared with that of a control toothpaste containing 5% potassium nitrate and 0.76% SMFP and a benchmark product containing only 0.76% SMFP. One hundred and two healthy volunteers, who had a minimum of 20 natural permanent teeth with no probing depth >4 mm and at least one sensitive tooth, participated in this study. Following enrollment, the subjects received a dental prophylaxis and instruction in brushing technique. After a 4-week pre-experimental phase, baseline gingival bleeding index (GBI), plaque index (PI) and visual analogue scales (VASs) indicating dentine hypersensitivity levels responding to tactile and air stimuli were assessed. The subjects were then randomly given one of the three toothpastes; test, control, or benchmark toothpaste, and a soft-filamented toothbrush for home use. The GBI, PI and VASs were re-examined at weeks 4 and 12. Overall, the GBI scores were significantly reduced compared with baseline in all groups (p<0.01). However, there was no significant difference in GBI score among the three comparison groups. The PI score decreased in the test group and benchmark group from baseline to the end of study, whereas there was no significant change in the control group. Post hoc comparison indicated that the PI score was not statistically different between the three groups. There was a significant difference between the three treatment groups for sensitivity. For both the tactile and air stimuli, the reductions in VAS sensitivity scores for the test group and the control group were significantly greater compared with the benchmark group. Although the sensitivity score for air stimulus decreased more rapidly from baseline to week 4 in the test group, there was no overall difference between the test group and the control group. This study demonstrated that the new toothpaste was effective in reducing dentine hypersensitivity. More studies are needed to further determine the potential interaction between triclosan and potassium nitrate in dentifrices.

A within-subject cross-over study was carried out to examine whether brushing with fluoride toothpastes would alter the composition of approximal plaque. Approximal plaque was collected from 22 subjects following brushing with toothpastes containing sodium fluoride and sodium monofluorophosphate with calcium glycerophosphate and a fluoride-free control toothpaste. Concentrations of plaque calcium, inorganic phosphorus, and fluoride were estimated. Toothbrushing with the fluoride toothpastes resulted in significantly greater concentrations of fluoride in approximal plaque when compared with the control toothpaste. However, there was no significant difference between the two fluoride toothpastes. The use of the sodium monofluorophosphate containing toothpaste resulted in significantly elevated concentrations of calcium and inorganic phosphorus in approximal plaque when compared to both sodium fluoride and control toothpastes. It was concluded that the use of a fluoride toothpaste can alter the chemical composition of approximal plaque.

Stannous fluoride dentifrice is well established for its beneficial clinical effects. In this study, we evaluated the effects of stannous fluoride on inflammation and oral microbiome. In this randomized, parallel-arm, double-blind, controlled clinical trial, we compared clinical resolution of experimental gingivitis by evaluating bleeding on probing, gingival index, and plaque index between stannous fluoride stabilized with zinc phosphate (test) and sodium fluoride (control) dentifrices. Further, these groups were compared for oral neutrophil counts, systemic priming of neutrophils, gingival crevicular fluid (GCF) expression of inflammatory markers, and the oral microbiome. We found significant reduction in bleeding on probing in the test group compared to the control group in experimental gingivitis when participants used the test dentifrice prior to induction of experimental gingivitis. The test group also showed significant reductions in GCF levels of inflammatory markers (matrix metalloproteinase 8 [MMP8], receptor activator of nuclear factor kappa-Β ligand [RANKL]), oral polymorphonuclear neutrophil (PMN) counts, and systemic neutrophil priming (CD11b expression) during experimental gingivitis. Further, significant reductions in the gram-negative genera Porphyromonas, Tannerella, and Treponema were noted in the test group. The stannous fluoride stabilized with zinc phosphate dentifrice formulation demonstrated clinical reduction in gingival inflammation and a beneficial effect on microbiome and immune markers. This intervention should be explored as a preventive aid in the progression of plaque-induced gingivitis to periodontitis.

Assessment of tubule occlusion properties of an experimental stannous fluoride toothpaste: A randomised clinical in situ study

Tooth decay is one of the most common infectious microbiological diseases in the world. Dental cavities are now less common than it was before water fluoridation was put into place. Fluoride toothpastes are of a high calibre and excellent at preventing tooth decay. Fluoride therapy administered by a specialist helps prevent dental caries. Common fluoride agents include sodium fluoride (NaF), sodium monofluorophosphate, stannous fluoride, and silver diamine fluoride. Fluorides are essential in the prevention of dental caries because they are therapeutically used to inactivate early carious lesions. Dental fluorosis brought on by unintentional ingestion has also been connected to early exposure to fluoride toothpaste.

We developed a method for the quantitative determination of sodium fluoride (NaF), sodium monofluorophosphate (SMFP) and amine fluoride (AmF) in toothpastes on the Belgian market. Samples were suspended in water and the determination was made using anion chromatography with conductivity detection after chemical suppression. The described ion chromatographic method is an easy and reliable isocratic high-performance liquid chromatography method for the determination of total soluble fluoride content in toothpastes. The analytical repeatability and reproducibility, the matrix effects and the method's decision limit of three different toothpastes containing NaF, SMFP and AmF at a concentration close to the permitted one of 0.15 g % total F are determined. All the samples analysed are in conformity with the Cosmetics Directive 76/768/EC; none exceeds the limit of 0.15 g %.

In vivo delivery of fluoride and calcium from toothpaste containing 2% hydroxyapatite